AIDS Death Toll at New High Despite Advances

As the world closes in on a new millennium, the AIDS conflagration continues to blaze out of control throughout most of the developing world.

Despite lowered death rates in the United States and Europe as a result of new drug therapies, more than 50 million people worldwide will have been infected by the AIDS virus and 16.3 million will have died by the end of the year, according to a report issued Tuesday by a United Nations program on HIV and AIDS. In 1999 alone, there will have been 2.6 million fatalities--the highest yearly total since the epidemic began two decades ago.

More than 70% of the HIV-positive live in sub-Saharan Africa, a region that contains only 10% of the world’s population. U.N. officials predict that life expectancy at birth in the region, which climbed from 44 in the early 1950s to 59 early this decade, will drop back to 45 sometime in the next five to 10 years.

The most glaring current hot spot, however, encompasses the former Soviet Union, where the proportion of the population living with HIV has doubled in only two years.

Women are increasingly bearing the brunt of the disease, according to the report. In sub-Saharan Africa, there are six HIV-positive women for every five such men--the first time infected females have clearly outnumbered males anywhere in the world. Among teenagers in the region, HIV-positive girls outnumber boys by five or six to one. More than 11 million children have lost their mothers to the disease.

Tragically, more than half the victims worldwide are under the age of 25, and few will live to see their 35th birthdays.

“The epidemic is far from over,” said Dr. Peter Piot, executive director of the UNAIDS program, at a London news conference Tuesday. “The crisis is actually growing.”

Dr. Roger Detels, an epidemiologist at UCLA, said: “The bottom line is, we need to be very concerned about the AIDS/HIV epidemic, despite the significant advances that have been made in treatment. The epidemic is continuing and, in some countries, continuing at a very high rate indeed.”

The tragedy, said Dr. Thomas Coates, head of the UC San Francisco AIDS Research Institute, “is that we know how to stop the epidemic but are just not willing to pay for it.” If developed countries spent only $2.5 billion on such an effort in developing countries, he said, “we could cut the infection rate in half.”

The money would be spent on condoms, marketing of condoms, treatment of other sexually transmitted diseases (which increase susceptibility to HIV), the use of antiviral agents during childbirth to prevent spread from mothers to children, testing of the blood supply, needle exchange programs and drug abuse treatment.

According to the new report, 5.6 million people will have been infected with the AIDS virus this year.

The spread of the disease has severe economic as well as personal consequences. According to a survey of commercial farms in Kenya, for example, illness and death have replaced retirement as the most common reasons for employees leaving their jobs. At one Kenyan sugar estate cited by the U.N. report, company spending on funerals increased fivefold between 1989 and 1997, and health care expenditures increased tenfold.

The steepest HIV growth curve, the report said, is in the former Soviet Union, where infection is the inevitable byproduct of startling rates of intravenous drug abuse. In the Russian Federation, nearly half of all cases of HIV infection reported since the start of the epidemic occurred in the first nine months of 1999.

Many of the infections were seen in large cities such as Moscow, but even remote regions are feeling the impact. In the Siberian city of Irkutsk, nearly 1,300 infections have been reported, most of them this year.

Drug abuse-related infections are also a growing problem in the Middle East. For instance, drug use is responsible for two-thirds of recorded cases of HIV infection in Bahrain, half of the cases in Iran and one-third of those in Tunisia. Although the actual number of cases is still small in those areas, U.N. officials expect the figures to grow dramatically because of other evidence that high-risk sexual practices are common.

Even in developed countries, the news is not all good. Despite the outlay of $3 billion a year in the United States for HIV therapy, the number of AIDS deaths is no longer dropping, indicating that there is a limit to the effectiveness of existing treatments.

Furthermore, some studies have suggested that the lowering of the death rate has led to a resurgence of risky sexual behavior among a population that has begun to view HIV infection as a controllable problem more like diabetes than cancer.

About 17,000 people died of AIDS in the United States last year, down from 50,000 two years ago. But 40,000 people developed new HIV infections.

There were some nuggets of good news in the report, however.

Some countries in Latin American have joined the ranks of those providing expensive antiviral drugs--including the new protease inhibitors--to the HIV-positive. Brazil, for example, spent about $300 million in 1999 providing drugs for about 75,000 people.

Brazilian authorities say they got at least $136 million of that back in savings on hospitalization and treatment for people with full-blown AIDS.

Argentina has also been providing antiviral drugs, leading to a 40% drop in the number of new AIDS cases in the last two years. But not all countries can afford this. Guatemala, for example provides drugs to just 185 people out of the more than 50,000 in the country who are HIV-positive.

Thailand’s well-established HIV prevention efforts are also bearing fruit. A study of pregnant women in the high-risk northern Thai province of Chiang Rai showed that the proportion who were HIV-positive fell from a peak of 6.4% in 1994 to 4.6% in 1997. The greatest reductions were seen in women under the age of 25.

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A Disease Unchecked

Here are the estimated numbers of AIDS deaths and existing cases worldwide by region.

*

*Estimated adult and child deaths because of HIV/AIDS from start of epidemic to end of 1999.

**Adults and children estimated to be living with HIV/AIDS as of the end of 1999

Source: UNAIDS